Michiana HIE shows that regional exchanges are feasible

A few weeks ago, I discussed two views of the future of regional health information exchanges (HIEs). A Harvard study in the Annals of Internal Medicine found that most HIEs were dependent on government grants and questioned whether the exchanges could ever be financially self-sustaining. In contrast, the eHealth Initiative, in its latest national study of HIEs, called sustainability "an attainable goal" for HIE organizations, citing that "there is a small but critical mass of sustainable organizations."

One of those HIEs is the Michiana Health Information Network, based in South Bend, Ind. Founded 11 years ago without help from state or federal grants, MHIN has been self-sustaining since at least 2006, according to Tom Liddell, the HIE's executive director. While MHIN is co-owned by a not-for-profit hospital and a not-for-profit reference laboratory, neither has put any additional capital into the enterprise in the past five years, Liddell tells FierceHealthIT. Monthly subscription fees from MHIN's participants have provided enough revenue to cover its operating expenses, allowing for growth.

Currently, MHIN includes 12 regional hospitals; the South Bend Medical Foundation, a regional reference lab; and 4,200 healthcare providers, of whom about 1,000 "receive substantial data benefits," according to Liddell.

MHIN sends a variety of patient information--including lab results, imaging reports, hospital discharge summaries, and surgical notes--directly to the electronic health records of 750 providers. Recently, the HIE has also been helping physicians with EHRs exchange continuity of care documents (CCDs), which are standardized clinical summaries.

When physicians go to the MHIN website to find data on a patient, they can access the information on Cerner PowerChart. Also available is MHIN Messenger, a secure clinical messaging service that the HIE developed in conjunction with Axolotl.

MHIN's success has been the result of concentrated hard work over time. For the first few years of its existence, Liddell says, the HIE mainly served as a way for hospitals to move lab results and reports to physicians, either online or by fax. Then, as MHIN tried to expand, it encountered political obstacles and questions about why institutions and providers should join MHIN if it didn't already have complete data on patients.

Cost was another barrier. Hospitals and physicians had to be persuaded that MHIN could provide them with a return on investment before they would pay its subscription fees, which are based on the size of the participating entity and how much data it uses.

Per Liddell, MHIN provides ROI to hospitals through:

  • Reductions in redundant testing of Medicaid and uninsured patients.
  • Eliminating fax, mail and courier costs for delivering lab results. "In a 300-bed hospital, that's a $100,000 to $200,000 effect," says Liddell.
  • Eliminating outbound interfaces to various practice EHRs. MHIN has created interfaces with 35 ambulatory-care EHRs. If a hospital tried to write and maintain those interfaces itself, it would have to add two or three IT people, Liddell points out.

Physician practices, too, benefit financially because they don't need multiple interfaces with hospitals and reference labs, Liddell notes. Even if a reference lab like Quest or LabCorp provided a free interface to a physician's EHR, it would send only results for the tests that doctor ordered, not results from any other tests done on that patient. And, without easy access to hospital results, the physician might have to repeat tests, which would not be efficient for the patient or the practice. 

Ultimately, the business case for regional HIEs depends on the value that participants get out of the information they gather from one another. The more connectedness becomes a core value of healthcare, the faster HIEs will grow. - Ken